- It is rare nowadays
- It is septic portal system thrombosis
- Commonly seen in immunosuppressed individuals.
- Infection spreads to liver through portal vein causing rapid multiplication of virulent organisms leading into septicaemia (toxaemia with hypotension, tachycardia), jaundice, tender palpable liver. Patient will be drowsy.
PROGNOSIS: -
- It carries poor prognosis.
- Pneumoperitoneum is not common in appendicular perforation.
- Appendicular artery which is an end artery can undergo infective thrombosis and can cause gangrene and perforation.
- In retrocaecal appendicitis rigidity is not common; psoas spasm is known to occur.
- Pelvic and post-ileal appendicitis can cause diarrhoea. Post ileal appendicitis is difficult to diagnose.
- It is difficult to remove subhepatic appendix through McBurney’s incision.
- Pain will be above and lateral in appendicitis in pregnant women. Appendicitis is the most common acute abdominal condition in pregnancy (1:1500 pregnancies). Incidence of foetal loss is 5% without perforation and it becomes 20% if there is perforation. It is better to do laparotomy to remove the appendix in pregnancy.
- In elderly atypical features are more common and so diagnosis is often missed. Gangrene and perforation are common in elderly. Often it mimics subacute obstruction
- In obese patients diagnosis is often difficult.
- Appendicitis is rare before 2 years. But when it occurs perforation and peritonitis are common carrying poor prognosis.
- Negative appendicectomy—incidence is 30%.
CAUSES AND DESCRIPTIONS: -
- Appendix is found on the left side in situs inversus patient. Situs inversus may be both thoracic and abdominal or only abdominal.
- Acute pancreatitis (straw/haemorrhagic chicken broth fluid), DU perforation (bile fluid), perforated Meckel’s diverticulum, twisted ovarian cyst/ectopic pregnancy (bloody fluid) are important lifethreatening conditions which may be missed for appendicitis and patient might undergo appendicectomy as a wrong procedure in these patients.
- Simple appendicitis is one where the symptoms are of less than 48 hours duration with imaging studies showing appendicitis without abscess or phlegmon.
- Chronic appendicitis’ earlier this term was not used, but is presently accepted terminology; few attacks of recurrent appendicitis will lead into chronic appendicitis. It presents with episodic often vague discomfort with colicky pain in RIF, anorexia, malaise, pain with movement and is often called as grumbling appendicitis. TC, US, CT scan may be normal in these patients
- Perforation rate in appendicitis is 25% in general; in children and elderly it becomes 45-50%. High fever more than 102°F, TC > 18,000/- are suspected features of rupture
- Mortality rate of appendicectomy is less than 1%. Morbidity and complications are more after surgery for perforated appendicitis
- Surgical site infection is 5% in uncomplicated appendicitis; 20% in perforated appendix after surgery
- Small bowel obstruction postoperatively is 1% with simple appendicitis; 3–5% in perforated appendicitis after surgery. More than 50% of obstruction occurs in first year of postoperative period
- In children with appendicitis, there is poor localisation and so peritonitis is common. So conservative therapy should be avoided. Surgery is the only choice of treatment otherwise early peritonitis is the danger.
- Appendicular mass is initially treated with Ochsner Sherren regime. After 6 weeks, interval appendicectomy is done.
- Children, old age, faecolith, laxative abuse, diabetes mellitus, immunosuppression and pelvic appendix are high-risk factors for perforation in appendicitis.
- In pelvic and retrocaecal appendicitis, adjacent ureteral inflammation can occur in which urine on analysis shows blood cells and pus cells.
HOMEOPATHIC MANAGEMENT: -
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